AUTHORIZATION TO START, STOP OR CHANGE AN ALLOTMENT AUTHORITY: 37 U.S.C. Section 701, E.O. 9397.
PRIVACY ACT STATEMENT
PRINCIPAL PURPOSE: To permit starts, changes, or stops to allotments. To maintain a record of allotments and ensure starts, changes, and stops are in keeping with member's desires. ROUTINE USES: In addition to those disclosures generally permitted under 5 U.S.C. Section 552a(b) of the Privacy Act, these records of information contained therein may specifically be disclosed outside the DoD as a routine use to the Federal Reserve banks to distribute payments made through the direct deposit system to financial organizations or their processing agents authorized by individuals to receive and deposit payments in their accounts. It may also be disclosed to the Treasury Department, Internal Revenue Service, Social Security Administration, Department of Veterans Affairs, Federal, state and local agencies for civil or criminal law enforcement. In addition it can be released for any of the blanket routine uses published at the beginning of the DFAS compilation of system of record notices. DISCLOSURE: Voluntary; however, failure to provide the requested information as well as the Social Security number may result in the member not being able to start, change, or stop allotments.
AIR FORCE
TO BE COMPLETED BY ALLOTTER 2. NAME OF ALLOTTER (Last, First, Middle Initial) (Print or type) MARINE CORPS
ARMY
NAVY
1. BRANCH OF SERVICE (X one)
5. ADDRESS OF ALLOTTER (Street or Box Number, City, State, ZIP Code)
9. NAME OF ALLOTTEE (First, Middle Initial, Last)
6. DAYTIME TELEPHONE NUMBER (Include Area Code)
3. SSN
4. PAY GRADE
7. EFFECTIVE DATE (YYYYMM)
STOP
$ 11. TERM IN MONTHS
10. ALLOTMENT ACTION (X one) START
8. MONTHLY AMOUNT OF ALLOTMENT
CHANGE
13. ALLOTMENT CLASS AUTHORIZED (X one)
12. CREDIT LINE (If applicable)
C - CHARITY/CFC
14. ALLOTTEE'S MAILING ADDRESS (Street or Box Number, City, State, ZIP Code)
D - DISCRETIONARY ALLOTMENTS (Includes dependent support, payment to financial institution, insurance, repayment of home loan, rent, etc. (Notes 1 and 2)) F - CHARITY - EMERGENCY/ASSISTANCE FUND CONTRIBUTION L - REPAYMENT OF LOAN TO SERVICE ORGANIZATION (Red Cross, Relief Society, etc. - Navy and Marine Corps only)
15. IF FOREIGN ADDRESS COMPLETE AS FOLLOWS (Province, Country)
N - NSLI OR USGLI INSURANCE PREMIUM T - PAYMENT OF DEBTS TO U.S., DELINQUENT STATE OR LOCAL INCOME/ EMPLOYMENT TAXES
16. REMARKS
- OTHER (Specify)
17. COMPANY CODE/FINANCIAL INSTITUTION/ROUTING TRANSIT NUMBER
18. ACCOUNT NUMBER/POLICY NUMBER
CHECKING SAVINGS
19. TOTAL CLASS L AMOUNT
$
20. TOTAL CLASS T AMOUNT
$
STATEMENT OF UNDERSTANDING I understand that this allotment is legal and that by voluntarily completing this form, I am responsible for: - Ensuring that the information is correct; - Reviewing my Leave and Earnings Statement to ensure the allotment stops, starts, or changes as directed including amount and payee; - Collecting overpayments from the receiver (payee) of the allotment, if I do not change or stop the allotment after a loan is repaid; - Contacting the receiver (payee) of the allotment, at my expense, to obtain monthly statements for my personal records. I also understand that any problems once the allotment is delivered to the receiver (payee) are beyond the control of the Defense Finance and Accounting Service (DFAS) and that DFAS is only responsible for ensuring proper delivery of any voluntary allotment for the period directed. I further understand that pursuant to conditions listed in the DoD 7000.14-R, Volume 7A, changes can be made by DFAS to an allottee's name, address, or account number. Under penalty of the Uniform Code of Military Justice, I certify that this allotment is NOT for the purchase, lease, or rental of personal property or payment toward personal property. 21. SIGNATURE OF ALLOTTER
22. DATE (YYYYMMDD)
NOTE 1. Must be different address than allotter. Each dependent allotment must have a different credit line. Only one support allotment per dependent is allowed. NOTE 2. This is a voluntary allotment and can be to any payee you desire.
DD FORM 2558, JAN 2015
PREVIOUS EDITION IS OBSOLETE.
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